Project Summary/Abstract Bariatric surgery is emerging as a safe and efficacious treatment for adolescent severe obesity, yet the durability of improvements and impact on patient well-being in the longer-term is largely unknown. This is a critical gap given adult evidence that patterns of optimal and suboptimal weight loss outcomes extend across the first post-operative decade or more, as well as by increased rates of alcohol use disorder (AUD) and risk of death by suicide. Unlike an adult, the adolescent patient's post-operative course cuts across known developmental periods where mental health disorders first emerge, and high risk behavior engagement peaks, including alcohol/tobacco/drug use, HIV/sexual-risk behaviors, and suicidal behaviors. Hence, tracking only adolescent physical health outcomes following bariatric surgery does not sufficiently capture the